st. anthony’s medical center and its forebears. · 2021. 8. 14. · f or more than 140 years,...

For more than 140 years, generations of St. Louisans have relied on the healing tradition of care provided by St. Anthony’s Medical Center and its forebears.

After an arduous trek across the Atlantic Ocean, the Franciscan Sisters of Germany in 1873 opened their first hospital in south St. Louis. Today, the leaders, physicians and employees of St. Anthony’s have advanced the mission of these intrepid sisters into the twenty-first century, using the latest technology and providing compassionate care second to none.

As the third-largest medical center in the St. Louis metropolitan area, St. Anthony’s is proud to set the standard for independent community health systems. Every day, our physicians and employees seek to improve the health and well-being of the residents in the communities we serve. We work as trusted partners with our patients, who come first in all we do.

Our work includes the development of a Community Health Needs Assessment (CHNA) during the last year, in collaboration with our partners in the medical community. To do this, we gathered and analyzed health-related information and statistics from St. Louis, St. Louis County and Jefferson County, Mo., and Monroe County, Ill. This information includes interviews with public health experts and those who represent the broad interests of the community served by the hospital, and surveys of community residents and local physicians.

The CHNA identified three top-priority health needs for the St. Anthony’s Medical Center community. We will strive diligently to address these needs over the next three years:

• Access to care • Mental health / Substance abuse • Healthy lifestyle

Please visit our website, stanthonysmedcenter.com, to read the CHNA and to learn more about our work. As always, we seek to develop a rich and rewarding network of partnerships with our neighbors. I welcome any thoughts you may have on ways to achieve our goal of a healthier community.

Sincerely,

David M. Sindelar Chief Executive Officer and Chairman of the Board St. Anthony’s Medical Center

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For a Healthier Tomorrow – Letter from CEO David Sindelar

Executive Summary

History of St. Anthony’s Medical Center .............................. 4

Needs Identified and Next Steps .......................................... 6

Our Community ................................................................. 6

Community Health Needs Assessment Process .................... 7• Community Survey ........................................................... 8• Physician Survey .............................................................. 10• Key Stakehold Analysis .....................................................11• Secondary Data Collection .............................................. 12

Identified Community Health Needs ................................ 21

Community Resources To Address Needs .......................... 22

Needs That Will Not Be Addressed ................................... 23

Appendices

Appendix I SAMC Service Area — Census Data ............ 24

Appendix II St. Anthony’s Community Survey Summary . 25

Appendix III Physician Survey Results ............................... 41

Appendix IV Key Stakeholder Analysis .............................. 44

Appendix V Data Sources ................................................ 50

TABLE OF CONTENTS

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BACkgrOuNd ANd PrOCESS

As part of the Patient Protection and Affordable Care Act (PPACA) passed in March 2010, every non-profit hospital is required to conduct a com-munity-based needs assessment every three years. St. Anthony’s Medical Center (SAMC) conducted a community health needs assessment (CHNA) and is developing a subsequent implementation plan with strategies to address identified needs that will be complete in November of 2016. This process was undertaken by the Community Outreach team at St. Anthony’s Medical Center, led by Community Benefit Manager Laura Bub, MPH.

The following are requirements for the CHNA:

• The CHNA must take into account input from individuals who represent the broad interests of the community served by the hospital, including those with knowledge and expertise in public health.

• The CHNA must be made widely available to the public.

• The hospital is required to adopt an implemen-tation strategy to meet the community health needs identified through the assessment process.

• As part of Schedule H of Form 990, St. Anthony’s also must submit in detail what the hospital will do and will not do in response to the CHNA.

St. Anthony’s collaborated with Barnes-Jewish West County Hospital (BJWCH), Missouri Baptist Medical Center (MBMC), St. Luke’s Hospital (SLH) and Mercy Hospital. St. Anthony’s Medical Center used survey data from community members and local physicians, a key stakeholder analysis, and secondary data from existing resources to identify and prioritize health problems and risk factors in the St. Anthony’s Medical Center service area.

History of St. Anthony’s Medical Center

St. Anthony’s Medical Center’s long and proud tra-dition of service to the St. Louis area began in 1873 when the Franciscan Sisters of Germany established a Catholic, faith-based tradition of health care in-spired by St. Anthony of Padua, who patterned his life and healing ministry after the example set by Jesus Christ. The sisters opened St. Anthony’s Hospital in south St. Louis in 1900.

As the community grew, the Franciscan Sisters made plans to expand the original facility. New wings were added in 1904 and 1928, establishing St. Anthony’s as a leading health care provider nationally and lo- cally. In the late 1940s and early 1950s, St. Anthony’s gained national recognition as the Midwest’s primary treatment center for polio victims. And in 1957, St. Anthony’s became one of the first hospitals in the area to offer cobalt cancer treatment.

EXECuTIVE SuMMArY

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In 1967, the Franciscan Sisters transferred ownership and control of the hospital to a board of community leaders, making St. Anthony’s the first Catholic hospital in the St. Louis area to be administered by a lay board. Following this transition, plans were made to relocate the hospital to south St. Louis County.

In 1975, St. Anthony’s Medical Center opened at its present location and remains the only hospital in south St. Louis County. Over the years St. Anthony’s has changed and grown to meet community needs, taking pride in the services it offers.

The mission, vision and values of St. Anthony’s Medical Center are vital statements that guide the conduct and decisions made by our leaders, physi-cians and employees. The mission describes what we do and have done for decades, and our vision expresses what we will be – for the patients we serve today and in the future.

Our Mission

St. Anthony’s, a Catholic medical center, has the duty and the privilege to provide the best care to every patient, every day.

Our Vision

Working as trusted partners, the physicians and employees of St. Anthony’s Health System will deliver care distinguished by its demonstrated quality and personalized service. We will be visibly engaged in improving the health and well-being of the communities we serve in South County and beyond. We will stand together, proud to set the standard for independent community health systems.

Our Values

• The patient comes first in all we do.

• We will strive for excellence through teamwork and mutual respect.

• We express compassion and respect for all persons served and those serving.

• As a Catholic medical center, we support the spiri-tual and physical needs of our patients and staff.

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Needs IdeNtIfIed

The three top health needs for the St. Anthony’s Medical Center community, as determined by the St. Anthony’s Medical Center Community Outreach team and reviewed by St. Anthony’s Medical Center’s Administration, are:

Next Steps

After carefully reviewing the data and mapping existing resources, St. Anthony’s Medical Center is developing an implementation plan with evidence-based strategies. The plan will be submitted to a committee of appointed members from St. Anthony’s Medical Center, for their approval. The final version of the CHNA and Implementation Plan will be available to the public on the St. Anthony’s Medical Center website, www.stanthonysmedcenter.com.

Community Served by the Hospital

St. Anthony’s Medical Center serves more than 616,000 residents in the St. Louis area, which covers St. Louis, our southern communities and several lo-cations in southwest Illinois. St. Anthony’s Medical Center is considered the third-largest medical center in the metropolitan area. Our needs assessment is targeted to our primary service area, which is defined as the zip codes where 80 percent of our patients live.

ZIP COdE TOwN/CITY COuNTY

62236 Columbia, Illinois Monroe 62298 waterloo, Illinois Monroe 63010 Arnold Jefferson 63012 Barnhart Jefferson 63020 deSoto Jefferson 63026 Fenton St. Louis 63028 Festus Jefferson 63049 High ridge Jefferson 63050 Hillsboro Jefferson 63051 House Springs Jefferson 63052 Imperial Jefferson 63109 St. Louis City St. Louis City 63111 St. Louis City St. Louis City 63116 St. Louis City St. Louis City 63118 St. Louis City St. Louis 63119 webster groves St. Louis 63122 kirkwood St. Louis 63123 Affton St. Louis 63125 Lemay St. Louis 63126 Crestwood St. Louis 63127 Sunset Hills St. Louis 63128 Sappington St. Louis 63129 Mehlville St. Louis

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The total population of the 23 zip codes listed above was 616,086 according to the 2014 U.S. Census. Estimated census data for 2019 lists the projected population at 621,220, a 0.8 percent increase in these zip codes. The average number of households in the estimated 2014 Census was 253,127, and that is projected to increase by 1.4 percent to 256,763 in 2019.

Average household income as represented by the 2014 estimated census data for the 23 zip codes was $68,882. The zip code with the highest average household income was 63122 (Kirkwood) at $108,143. The zip code with the lowest average household income was 63111 (St. Louis City) at $47,064.

In terms of race, St. Anthony’s Medical Center patients are predominantly white (95 percent) compared to St. Louis County (69.9 percent), Jefferson County (96.4 percent) and Monroe County residents (98 percent). African Americans or Blacks account for 3 percent of St. Anthony’s patients, 23.9 percent of St. Louis County residents, 1.1 percent of Jefferson County residents and 0.4 percent of Monroe County residents. Other races account for 1 percent of St. Anthony’s patients, 4.2 percent of South County residents, 1 percent of Jefferson County residents and .7 percent of Monroe County residents. The median age for the 23 zip codes analyzed was 40.3.

Please see Appendix I for a table of census data for the SAMC service area.

Community Health Needs Assessment Process

St. Anthony’s Medical Center sought to conduct its needs assessment using primary and secondary data. Primary data were collected in three ways –a telephone survey of 500 adult community members; physician surveys and a collaboration of key stake-holders in a focus group setting.

3% OF PATIENTS AT ST. ANTHONY’S ArE

AFrICAN AMErICAN.ALL OTHEr rACES COMBINEd COMPrISE THE rEMAININg 1%.

96% ArE wHITE.

LOwEST OVErALL HIgHEST AVErAgE AVErAgE AVErAgE

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ST. ANTHONY’S MEdICAL CENTEr COMMuNITY SurVEY ANd FINdINgS

St. Anthony’s Medical Center partnered with the Prell Organization to assess the health-care needs of the community by conducting a telephone survey with both landline and cell-phone numbers utilizing a random sample of 500 adults age 21 years or older. This sample of our population is representative of the community served by St. Anthony’s Medical Center. These interviews were conducted in June 2015 at Communications for Research in Steelville, MO, using a CATI (Computer Assisted Telephone) interviewing system.

The research was conducted in a method designed to determine the following health needs of the population St. Anthony’s Medical Center serves:

1. Health care issues

2. Personal health issues

3. Health care utilization

4. Personal health habits

5. Demographic differences

A stratified random sample was employed that set quotas for each geographic segment to match the proportions of the overall adult population in the PSA. This had the effect of reducing the sampling error for this survey. For the purpose of the analysis, the zip codes were collapsed into five geographic segments, as seen in the following chart.

SOuTH NOrTH S. JEFF / CITY OF MId- COuNTY JEFFErSON ILLINOIS ST. LOuIS COuNTY

63126 63051 62236 63109 63119

63127 63052 62298 63111 63122

63128 63049 63012 63116 63123

63129 63010 63020 63118 63125

63026 63028

63050

Key Findings

• Health care costs are still the principal pain point for consumers: the biggest health care problem and the largest barrier to obtain medical care. Lowering costs is considered to be the best way to improve the health of the community. Even though the rate of increase in health care costs has slowed considerably, as long as employers continue to shift more of the burden to their em-ployees, cost will be consumers’ biggest concern.

• Although the Affordable Care Act law (ACA) was passed in 2010, its influence on consumer choice was not felt until the health care exchanges were rolled out after our previous Community Health Needs Assessment survey. Since then the ACA has had a clear and measurable impact on consumers, as health care costs (and the law itself) are now perceived to be bigger problems, while the availability and cost of health insurance are less troublesome.

• There are indications that health care quality may be slipping, even though these changes are not yet statistically significant. Not only do fewer people have a primary care physician (than in 2012), but gaining access to a physician is one of the main barriers they face. And, despite the stated goal of the ACA to increase health insurance coverage, there are now fewer people self-reporting being covered by managed care than there were in 2012.

• On the other hand, the health condition of the population is relatively stable and citizens report healthy personal habits: more physical exercise than in 2012, daily consumption of fruits and vegetables, and lower rates of cigarette smoking (with a shift to e-cigarettes). Despite these physical manifestations of good health, consumers are now less confident that they can manage the chronic conditions present in their households.

• Endocrinology and cardiology are the two largest specialties used by the community. Diabetes has the highest incidence of chronic illnesses, affecting almost 10 percent of all households, and a major-ity of people know someone personally with this condition in their community. In addition, heart

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disease impacts nearly one in ten households and about one-half know someone with this problem.

• While mental health and substance abuse are not mentioned very often as chronic illnesses (unaided), there is a much higher awareness that these prob-lems are prevalent within the community. The gap between the number reporting a household member and knowing someone personally suggests there is considerable community support for treating these diseases, although family support for these patients may be lacking.

• Residents in both ends of Jefferson County have serious challenges accessing medical care, evi-denced by less education, health problems that aren’t being addressed well and generally poorer

health. People in northern Jefferson County also need to overcome some additional issues: less access to primary care physicians; a greater dependence on almost all tobacco products; and a greater likeli-hood to be on Medicaid or to have no insurance.

• The three areas identified by SAMC’s previous Community Health Needs Assessment (2013) are still significant areas of vulnerability for at-risk citizens: mental health, diabetes (plus obesity) and access to care (particularly cost and geographic barriers). Because the health care environment is still evolving rapidly, these issues are likely to present challenges to community members for the foreseeable future.

Please see Appendix II for the survey tool.

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ST. ANTHONY’S MEdICAL CENTEr PHYSICIAN SurVEY ANd FINdINgS

Physicians play a very important role in looking at the health needs of our community, because they often are the first point of contact when it comes to health issues. Physicians also play a key role in establishing good preventive health behavior, and may also be a key to finding out why patients are or are not on the road to good health.

Because physicians play this role in recognizing the health needs of the population, we chose to survey primary care physicians and specialists affiliated with St. Anthony’s Medical Center. Forty-three physicians took part in a seven-question survey using an online survey tool. The physicians were asked three open-ended questions and four closed questions focused on the health needs of our population.

Key Findings

• Diabetes, obesity and lifestyle were mentioned the most often in response to the biggest health care problem facing the community. When ask how well that problem is being addressed in the community, 54.76 percent of the physicians responded “not too well.”

• There were many mentions of patients unable to take their health into their own hands and prop- erly manage their chronic conditions. The survey indicated that they lack the motivation to become healthier and to make changes that would improve their health outcomes.

• 59.2 percent of physicians responded that sub-stance abuse, including drugs and alcohol abuse, is a big problem in the community. Only 2.38 percent responded that it was not a problem at all.

• Of the chronic illnesses or conditions that physi-cians see in their patients, obesity, anxiety and depression and diabetes are listed as the top three. In an open-ended question about the biggest barrier to a patient being able to manage their chronic disease or condition, overall cost for patients was mentioned 21 times. Lack of motiva-tion/accountability was mentioned 16 times and lack of support and a need for more education was mentioned eight times.

• Physicians responded that the #1 type of health education needed by members of the St. Anthony’s Medical Center community is diet and exercise education, following by mental health and a tie between drug abuse and diabetes education.

• When physicians were asked what a hospital like St. Anthony’s can do to improve the health of their patients and others in the community, 22 men-tioned expanding wellness programs, education and screenings.

Please see Appendix III for complete survey questions and physician responses.

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kEY STAkEHOLdEr ANALYSIS

As part of the requirements of the PPACA, non-profit hospitals are encouraged to conduct their assessment in collaboration with other hospitals, local health departments and /or community partners. In the Key Stakeholder Analysis, St. Anthony’s Medical Center partnered with Barnes Jewish West County Hospital (BJWCH), Missouri Baptist Medical Center (MBMC), St. Luke’s Hospital (SLH) and Mercy St. Louis. Input was sought from those who represent the broad interests of the community served by the hospital as well as those who have special knowledge and expertise in the area of public health.

To fulfill PPACA requirements, BJWCH, MBMC, SAMC, SLH and Mercy St. Louis hosted a single focus group with public health experts and those with a special interest in the health needs of residents located in west and south St. Louis County. This focus group was held on July 23, 2015. This group was facilitated by Angela Ferris Chambers, Manager of Market Research and CRM for BJC HealthCare. The discussion lasted 90 minutes.

Perception Of 2012/2013 Priorities

There was general consensus that the priorities identified in the previous assessment are still those on which the hospitals should focus. Many expressed the desire to reevaluate the priorities and integrate additional needs into the list of those being addressed.

Rating Of Needs

Participants were given the list of the needs identified in the 2012/2013 assessment by each hospital and asked to re-rank them on a scale of 1 (low) to 5 (high), based on their perceived level of community concern and the ability of community organizations to col-laborate around them.

LEVEL OF ABILITY TO CONCErN COLLABOrATE

Behavioral/Mental Health 4.6 4.5

Alcohol/Substance Abuse 4.6 4.4

Maternal/Child Health 4.5 3.9

Access to Services 4.4 4.5

Seniors Svcs/Social Support 4.1 3.9

diabetes 4.1 3.8

Access to Coverage 3.9 4.0

Heart & Vascular disease 3.9 3.9

Violence 3.9 3.8

Cultural Literacy 3.9 4.0

Health Literacy 3.8 3.8

Cancer: Colon 3.8 3.2

Cancer: Lung 3.6 2.9

Tobacco use 3.6 3.6

Cancer: Skin 3.4 2.9

Cancer: Breast 3.1 3.2

Behavioral/mental health and alcohol/substance abuse rated highest in terms of level of concern and ability to collaborate. Interestingly, breast cancer rated lowest on level of concern. Skin cancer and lung cancer tied for lowest on ability to collaborate.

See Appendix IV for more detail.

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SECONdArY dATA

Secondary data were collected by a variety of means, from local, county, state and hospital sources. These secondary data are important in creating a profile of the community that St. Anthony’s serves.

There are limitations to the available data on our community. Most data are available only at the county level, as opposed to a detailed zip code analysis that would allow a more thorough look at sub-county information. Analysis of these data focused heavily on St. Louis County and Jefferson County in Missouri, because these are the two largest in our community. Another limitation is the lack of available data on our vulnerable populations, including low-income and minority groups.

St. Anthony’s Medical Center ER Data

St. Anthony’s Emergency Room saw 76,412 patients from July 1, 2014 to June 30, 2015. St. Anthony’s Medical Center’s Urgent Cares saw 80,646 patients during the same time period. Emergency Rooms and Urgent Cares are often the safety net for both insured and under-insured patients. The Emergency Room can provide medical care for the uninsured, but it also serves as one of the only options for evening or weekend care for members of the community who cannot see their physician during regular business hours. Below are the ICD9 Summary Codes for cases seen in the St. Anthony’s Medical Center Emergency Room. It is important to examine these emergency department diagnosis codes to gain insight about conditions seen over a particular time period.

Total St. Anthony’s Medical Center ER Cases for 2015 – 76,412

CASELOAd BY TOP NuMBEr OF CASES PErCENTAgE OF TOTAL CASES

Injury and Poisoning (800-999) 15,547 20%

Symptoms, Signs and Ill-defined Conditions (780-799) 14,462 19%

diseases of the respiratory System (460-519) 7,808 10%

diseases of the digestive System (520-579) 6,348 8%

diseases of the Circulatory System (390-459) 5,261 7%

Mental disorders (290-319) 5,127 7%

diseases of the Musculoskeletal System and Connective Tissue (710-739) 4,466 6%

diseases of the genitourinary System (580-629) 4,447 6%

diseases of the Nervous System and Sense Organs (320-389) 3,496 5%

Infectious and Parasitic diseases (001-139) 2,576 3%

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The total percentage of self-pay patients for the Emergency Room is 12 percent. To understand better what self-pay patients are coming to the Emergency

Room, we have included the table below that breaks out the top ten diagnosis codes for self-pay patients for the dates of 7/1/2014 to 6/30/2015.

Below is a breakdown of patients in the Emergency Room by payor mix, to gain insight into the method

of payment and ratio of insured patients that are seen at St. Anthony’s Medical Center.

MEdICArE 34%MANAgEd CArE 33%

wOrkErS COMP 1%

COMMErCIAL 1%

CHAMPVA 1%

SELF PAY 12%MEdICAId 18%

rANk PrIMArY ICd9 dIAgNOSIS PrIMArY ICd9 dIAgNOSIS dESCrIPTION TOTAL

1 786.5 CHEST PAIN NOS 227

2 525.9 dENTAL dISOrdEr NOS 217

3 599 urIN TrACT INFECTION NOS 186

4 311 dEPrESSIVE dISOrdEr NEC 182

5 789 ABdMNAL PAIN uNSPCF SITE 155

6 847 SPrAIN OF NECk 141

7 789.09 ABdMNAL PAIN OTH SPCF ST 125

8 724.2 LuMBAgO 105

9 847.2 SPrAIN LuMBAr rEgION 104

10 493.92 ASTHMA NOS w (AC) EXAC 102

Primary Diagnoses For Discharged, Self-Pay Emergency Room Patients: 7/1/2014 – 6/30/2015

Emergency Room Patients By Payor Mix: 7/1/2014 – 6/30/2015

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Patients Without A Primary Care Physician

Below is a summary of patients for the same time period that visited St. Anthony’s Medical Center on an inpatient or outpatient basis, that upon being admitted, stated that they did not have a primary care physician. Not utilizing a primary care doctor can mean that these members of our community are not getting the preventative care needed to keep them healthy and out of the hospital.

PATIENTS wITHOuT A PrIMArY CArE PHYSICIAN

discharge Fiscal Year 2015

In-Patient 4,596

Out-Patient 42,141

Total Patients without PCP 46,737

Percent of Total Patients 13%

Key Findings

• The payor mix data indicates that the self-pay and Medicaid patients together account for 30 percent of patients. Those patients with private insurance (Managed Care) account for 33 percent of patients

• Self –pay patients in the Emergency Room account for 12 percent of patients. Self-pay means someone chooses to pay for their treatment directly instead of using private insurance

• Of the self-pay patients, the top ten diagnosis codes are indicative of care that would benefit from a person having a PCP (primary care physician) and preventative care

• Of all of the patients seen at St. Anthony’s Medical Center between July of 2014 and June of 2015, 13 percent did not have a PCP (primary care physician) upon being admitted

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More than one million people in the United States are diagnosed with cancer each year. Below is an examination of local cases and a comparison of

Deaths due to cancer are higher overall for Jefferson County than for St. Louis County, or the state of Missouri as a whole. Lung cancer rates for Jefferson County are much higher – a rate of 74 in comparison to 49 for St. Louis County or 59 for Missouri,

St. Louis County statistics with those of Jefferson County (Monroe County, IL was excluded due to a lack of comparable data).

which ties closely with the adult smoking rate being higher in Jefferson County than the state and national average. To further break down cases via gender, below are the top ten cancer incidence sites for both men and women in St. Louis and Jefferson Counties.

ST. LOuIS COuNTY JEFFErSON COuNTY STATE OF MISSOurI

data Years Age-Adjusted Rate Age-Adjusted Rate Age-Adjusted Rate

All Cancers: deaths (Malignant Neoplasms) 2003-2013 175 209 189

Colorectal Cancer deaths 2003-2013 16 18 18

Colon and rectum Cancer 2003-2013 16 18 17

Lung Cancer 2003-2013 49 74 59

Breast Cancer 2003-2013 15 13 14

Cervical Cancer 2003-2013 2 1 1

Prostate Cancer 2003-2013 7 8 8

Cancer

• Source: Data courtesy of Missouri BRFSS http://health.mo.gov/data/CommunityDataProfiles/• Death rates are per year per 100,000 population and are age-adjusted to the U.S 2000 standard population

FEMALES

Cancer Site St. Louis County

Breast 31.17

Lung & Bronchus 14.37

Colon & rectum 9.26

Corpus and uterus, NOS 6.21

Non-Hodgkin Lymphoma 4.06

Melanoma of the Skin 3.25

Thyroid 3.24

Pancreas 3.02

kidney & renal Pelvis 2.81

Ovary 2.71

FEMALES

Cancer Site Jefferson County

Breast 28.53


Colon & rectum 9.66

Corpus and uterus, NOS 5.74

Thyroid 4.44


Non Hodgkin Lymphoma 3.83

Pancreas 2.96


Leukemia 2.65

• Source – Missouri Cancer Registry and Research Center – Missouri County Data (2007-2011)

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MALES

Cancer Site St. Louis County

Prostate 28.90


Colon & rectum 9.65

urinary Bladder 6.65




Oral Cavity & Pharynx 3.13

Leukemia 3.03

Pancreas 2.66

MALES

Cancer Site Jefferson County

Prostate 22.17


Colon & rectum 10.13

urinary Bladder 6.04




Leukemia 3.59

Oral Cavity & Pharynx 3.48

Pancreas 2.64

• Source – Missouri Cancer Registry and Research Center – Missouri County Data (2007-2011)

TOP SITES dIAgNOSEd AT ST. ANTHONY’S IN 2013 TYPE OF CANCEr PErCENT OF ALL CASES

1. Breast - Female 17.96%

2. Lung 17.38%

3. Melanoma Skin 8.41%

4. Prostate 8.19%

5. Colon 7.96%

6. urinary Bladder 4.96%

7. kidney 4.66%

8. rectum 3.38%

9. Non-Hodgkin Lymphoma 2.63%

10. Pancreas 2.18%

County Health Rankings

County Health Rankings measure the health of nearly all counties in the nation and rank them within states. The rankings are compiled using county-level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically-informed weights. The rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn work and play.

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HEALTH OuTCOMES ST. LOuIS COuNTY JEFFErSON COuNTY MONrOE COuNTY, IL uS BENCHMArk LENgTH OF LIFE Premature death 6,700 7,800 5,300 5,200 Years of potential life lost before age 75 per 100,000 population

QuALITY OF LIFE Poor or Fair Health 14% 15% 10% 12% Poor Physical Health days in a 30 day period 3.6 3.8 2.8 2.9 Poor Mental Health days in a 30 day period 3.5 3.7 3 2.8 Low Birthweight 9% 7% 7% 6% HEALTH FACTOrS HEALTH BEHAVIOrS Adult Smoking 17% 21% 13% 14% Adult Obesity 28% 31% 33% 25% Food Environment Index 7.1 7.4 8.7 8.3 Physical Inactivity 23% 31% 27% 20% Access to Exercise Opportunities 97% 81% 71% 91% Excessive drinking 15% 18% 23% 12% Alcohol-impaired driving deaths 35% 34% 61% 14% Sexually Transmitted Infections 520.9 215.7 173.9 134.1 Teen Births 24 30 12 19 CLINICAL CArE uninsured 12% 13% 8% 11% Primary Care Physicians 830:1 4340:1 2580:1 1040:1 dentists 1200:1 3180:1 1410:1 1340:1 Mental Health Providers 400:1 1270:1 890:1 370:1 Preventable Hospital Stays 48 72 71 38 diabetic Monitoring 86% 87% 88% 90% Mammography Screenings 69% 65% 73% 71% SOCIAL & ECONOMIC FACTOrS High School graduation 88% 90% 91% 93% Some College 77% 66% 73% 72% unemployment 5.80% 6.30% 5.40% 3.50% Children in Poverty 14% 15% 6% 13% Income Inequality 4.7 3.7 3.50 3.7 Children in Single-Parent Households 34% 28% 19% 21% Social Associations 9.7 8.0 14.9 22.10 Violent Crime 312 237 50 59 Injury deaths 65 81 56 51 PHYSICAL ENVIrONMENT Air Pollution-Particulate Matter 11.7 11.5 11.9 9.5 drinking water Violations No Yes Yes No Severe Housing Problems 15% 11% 9% 9% driving Alone to work 84% 85% 85% 71% Long Commute - driving Alone 31% 52% 53% 15%

* Data courtesy of County Health Rankings and Roadmaps

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Key Findings

• All three counties had a slightly higher incidence of premature death than the US benchmark.

• In terms of adult smoking, the percent of Jefferson County adults who smoke was at 21 percent, as opposed to 14 percent for the US benchmark.

• Adult obesity rates are 25 percent for top US performers. All three counties are higher in com-parison – 28 percent for St. Louis County, 31 percent for Jefferson County and 33 percent for Monroe County, IL. Physical inactivity is also higher for all three counties.

• Excessive drinking was higher for all three counties, but most troubling was the percentage of excessive drinking for Monroe County – which was at 23 percent. Alcohol-impaired driving deaths were much higher across the board for all three counties. The US benchmark is 14 percent of driving deaths are due to alcohol involvement. St. Louis County had 35 percent, Jefferson County had 34 percent and Monroe County had 61 percent.

• The sexually transmitted infection rate for the US benchmark was 134.1 while St. Louis County had a rate of 520.9.

• In terms of access to preventative care, Monroe County and Jefferson County have less access to primary care doctors, dentists and mental health providers. This may be the reason that preventable hospital stays are higher than the US benchmark.

• In terms of social and economic factors, the high school graduation rate is slightly lower for all three counties in comparison to top US performers. Unemployment is also higher for all three counties.

• The rate of violent crime (number of violent crime offenses reported per 100,000 population) is very high for St. Louis County (312) in relation to the US benchmark (59).

• Out of all 115 Missouri counties, St. Louis County ranked #20 and Jefferson County ranked #33. Of 102 Illinois counties, Monroe County ranked #3.

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CHrONIC dISEASE COMPArISONS PrOFILE FOr ST. LOuIS COuNTY ANd JEFFErSON COuNTY rESIdENTS ST. LOuIS COuNTY JEFFErSON COuNTY

data Number Age-Adjusted Number Age-Adjusted Age-Adjusted Years of Events rate of Events rate State rate

Hospitalizations: Heart disease 2009-2013 73,388 120 14,553 132 123

Hospitalizations: Ischemic Heart disease 2009-2013 19,494 32 5,011 44 38

Hospitalizations: Lung Cancer (SEEr) 2009-2013 2,639 4 673 6 4

Hospitalizations: Asthma 2009-2013 7,828 16 1,119 10 12

HEArT dISEASE

deaths: Heart disease 2003-2013 28,669 205 4,834 249 217

Ischemic Heart disease

deaths: Ischemic Heart disease 2003-2013 21,363 152 3,578 182 145

STrOkE/OTHEr CErEBrOVASCuLAr dISEASE

deaths: Stroke and 2003-2013 6,144 44 1,042 56 48

Other Cerebrovascular disease

ALL CANCErS (MALIgNANT NEOPLASMS)

deaths: All Cancers (Malignant Neoplasms) 2003-2013 23,293 175 4,544 209 189

LuNg CANCEr (SEEr)

deaths: Lung Cancer (SEEr) 2003-2013 6,527 49 1,657 74 59

CHrONIC OBSTruCTIVE PuLMONArY dISEASE EXCLudINg ASTHMA

deaths: Chronic Obstructive Pulmonary 2003-2013 4,428 32 1,184 60 49

disease Excluding Asthma

SMOkINg-ATTrIBuTABLE (ESTIMATEd)

deaths: Smoking-Attributable (Estimated) 2003-2013 16,156 119 3,738 175 145

• Death rates are per year per 100,000 population and are age-adjusted to the U.S 2000 standard population • Hospitalization rates are per year per 10,000 population and are age-adjusted to the U.S. 2000 standard population • Fewer than 20 events in numerator; rate is unstable. • Trends are available only if each 3-year period of the moving average has an average of 20 or more events. Source: Missouri BRFSS http://health.mo.gov/data/CommunityDataProfiles/

Missouri’s Behavioral Risk Factor Surveillance System (BRFSS) is a population-based survey conducted throughout the year, with sampling for state- level estimates. BRFSS questions are revised annually, and some questions are not asked every year. The two most recent years of BRFSS data available –

2009 to 2013 – were obtained to compute indicators. Comparable Monroe County, IL data was not available for this comparison. When you compare St. Louis County and Jefferson County chronic disease profiles to state rates, there are definitely some statistics that set the two counties apart from Missouri as a whole.

Missouri Behavioral Risk Factor Surveillance System

19

• From 2009-2013, Jefferson County has a slightly higher rate of hospitalizations due to heart disease (132) than St. Louis County (120) or the State of Missouri (123)

• Hospitalizations for ischemic heart disease trended higher for Jefferson County (44) than the state level (38) or for St. Louis County (32)

• Hospitalizations for lung cancer were at a rate of 6 for Jefferson County than a rate of 4 for St. Louis County and the state of Missouri.

• Hospitalizations for asthma is higher for St. Louis County (16) than Jefferson County (10) or the state of Missouri (12)

• Deaths from heart disease are considerably higher for Jefferson County (249) than for St. Louis County (205) and the state of Missouri (217)

• Deaths from ischemic heart disease are higher for Jefferson County (182) and St. Louis County (152)

than the state average (145)

• Deaths due to stroke and other cerebrovascular diseases are higher in Jefferson County (56) than they are in St. Louis County (44) or the state of Missouri (48).

• Deaths due to all types of cancers are at a rate of 209 for Jefferson County compared to 175 for St. Louis County and 189 for the state of Missouri.

• The rate of lung cancer deaths in Jefferson County is high at 74, compared to 49 for St. Louis County and 59 for the state of Missouri.

• Deaths due to COPD (chronic obstructive pulmonary disease) excluding asthma was high in Jefferson County (60) compared to 49 for the State of Missouri and 32 for St. Louis County.

• Jefferson County has a high rate of smoking-attributable deaths (175) compared to 119 for St. Louis County and 145 for Missouri.

Key Findings

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IdENTIFIEd COMMuNITY HEALTH NEEdS

The St. Anthony’s Medical Center Community Outreach team reviewed the results from the com-munity and physician surveys, the key stakeholder assessment and targeted secondary data pertaining to our defined community.

Using these sources, members identified needs based on the following criteria: severity of the need, resources currently available or unavailable in the

community to address the need, and ability to make long-term impact on the health of our community.

It is not surprising that in our research, the majority of community concerns closely mirrored the needs that we identified in our 2012 needs assessment. While groundwork has been laid to address these concerns, further work on these initiatives is needed. The following were chosen as St. Anthony’s Medical Center’s three main priorities in improving the health of our community for 2016-2018:

Access To Care

Access to care is an issue in our community, especially with our Jefferson County population and our vulnerable populations. Access to care goes hand in hand with our community members not taking the right preventative steps to getting the health care they need. Without the right preventative care, health outcomes suffer.

Mental Health / Substance Abuse

There is overwhelming evidence of the need for increased awareness and education about mental health issues in our community. Support for our community members and their impacted families who suffer with mental health issues was realized heavily throughout the assessment. Substance abuse also falls under our Mental Health priority as substance abuse is seen across all three counties as an issue that needs to be addressed.

Healthy Lifestyle

The rates of obesity and diabetes are on the rise nationally, and the state of Missouri and our community is no exception. Both St. Louis County and Jefferson County have high rates of population that are overweight and obese. Taking ownership of a healthy lifestyle and connecting with the right com-munity resources can vastly improve the health outcomes of our community.

These priorities will be what guides our subsequent Implementation Plan. Through the established priorities, St. Anthony’s will seek to increase access and improve health status, especially for the most vulnerable and unserved individuals in our community.

21

St. Anthony’s Medical Center Internal Resources

Fitness And Exercise Classes

Includes Arthritis Foundation Exercise Class, Pilates, PiYoga, Senior Strength and Balance, Foam Roller Exercise, Stability Ball for Strength, Strength Training for Women, Stretch, Balance and Strength for Seniors, T’ai Chi for Health, Basic Yoga, PiYoga, Chair Yoga, Gentle Yoga and Zumba.

Wellness Programs and Classes

Heartsaver CPR, Newtritious You, Bike helmet fittings, Nutrition Counseling, Diabetes Education

Events/Screenings (On-campus and in the Community)

Skin cancer screenings, Cholesterol screenings, Leg and Venous screenings. Events such as Physician lec- tures and preventative health education at large-scale community events such as Pink Night at the Movies, and Hearts & Handbags

Speakers Bureau

Includes topics such as heart health, life and family health, orthopedics, stroke, senior safety and care, cancer, diabetes and nutrition. Topics also can be customized for community groups.

Support Groups & Classes

Health Related: Amputee Support Group, AWAKE Support Group, Cancer Support Group, Cardiopul-monary Support Group, Diabetes Support Group, Look Good/Feel Better Support Group, Man to Man Prostate Support Group, Stroke Club, Women with Breast Cancer Support Group, Women Heart Group

Behavioral Health Support: Anger Management classes, Adult Children of Alcoholics, Alateen, Pre-Alateen, Alcoholics Anonymous, Al-Anon, Al-Anon Newcomers, CODA, Depressive/Manic Depressive Support Group, Narcotics Anonymous, Nicotine Anonymous, Gamblers Anonymous, Overeaters Anonymous

Other: Hospice Support Group, Grief Support Group, New Moms’ Network

Senior Services

Transportation program, One Stop/One Call for physician appointments and testing, personal as-sistance and follow-up care

Current Community Partnerships

St. Anthony’s actively partners with our community. Here are examples of some of our community partners:

• St. Louis County Health Department

• South County YMCA

• School districts in our service area

• Parents as Teachers programs in five local school districts: Affton, Hancock, Kirkwood, Lindbergh and Mehlville

• Non-profit groups such as the American Cancer Society (ACS)

• Other schools, churches, and organizations (health-care resources to educate our community)

• Local employers and businesses (Community Health and Wellness department’s on-site screen-ings, flu shots and other services)

COMMuNITY rESOurCES TO AddrESS NEEdS

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Behavioral Health Services

COMTREA – Community Mental Health Center for Jefferson and south St. Louis counties

Health Departments

Monroe County Health Department, St. Louis County Health Department, Jefferson County Health Department

Health Service Facilities (free and reduced-rate services)

South County Health Center, Jefferson County Nursing Clinic

NEEdS THAT wILL NOT BE AddrESSEd

In any case of prioritization, there will be some areas of needs that are identified that are not chosen as a priority. Because St. Anthony’s Medical Center has limited resources, not every community need will be addressed. Throughout the CHNA process, the following needs arose as community concerns. How- ever, they will not be addressed at this time due to the need already being addressed by another community organization or due to a limitation of resources:

Other Hospitals

SSM St. Clare (Fenton), Mercy Jefferson, St. Luke’s, BJC West County, Missouri Baptist Medical Center, Mercy Hospital

Recreational Facilities

Arnold Recreational Facility (St. Louis County Parks and Recreation), Riverchase Recreational Facility

YMCA

Monroe County YMCA of Southwest Illinois, South County YMCA

• Tobacco use in Jefferson County

• Violence in the Community

• Maternal/Child Health

• Sexually Transmitted Infections

• Alcohol-impaired Driving Deaths

While these needs listed will not be specifically addressed in our priorities, they will most likely be impacted indirectly through the work in our other community outreach priorities.

External Resources

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24

CENSuS dATA

rACE ST. ANTHONY’S PATIENTS ST. LOuIS COuNTY JEFFErSON COuNTY MONrOE COuNTY, IL

white 95% 69.9% 96.4% 98.0%

Black/African American 3% 23.9% 1.1% 0.4%

Other race 1% -- -- --

Asian 0% 4.0% 0.7% 0.5%

Native Hawaiian or Pacific Islander 0% 0.0% 0.0% 0.0%

American Indian or Alaska Native 0% 0.2% 0.3% 0.2%

*Hispanics may be of any race, so also are included in applicable race categories

Population 2010 Estimated Projected 2010-2014 Projected 2014 2014 Avg

Zip Code County Population 2014 2019 % Change 2014-2019 Median Household Population Population % Change Age Income

62236 Columbia, IL Monroe 12,685 13,137 13,589 3.6% 3.4% 41.1 $86,499

62298 waterloo, IL Monroe 16,513 16,832 17,143 1.9% 1.8% 42.3 $84,358

63010 Arnold, MO Jefferson 36,126 35,872 35,653 -0.7% -0.6% 39.0 $62,624

63012 Barnhart, MO Jefferson 10,152 10,339 10,558 1.8% 2.1% 37.7 $71,868

63020 de Soto, MO Jefferson 20,768 20,751 20,762 -0.1% 0.1% 39.9 $50,424

63026 Fenton, MO Jefferson 43,483 44,593 45,859 2.6% 2.8% 39.5 $76,298

63028 Festus, MO Jefferson 26,648 26,931 27,268 1.1% 1.3% 39.6 $59,031

63049 High ridge, MO Jefferson 16,430 16,460 16,512 0.2% 0.3% 38.7 $66,120

63050 Hillsboro, MO Jefferson 15,390 15,537 15,715 1.0% 1.1% 39.7 $64,095

63051 House Springs, MO Jefferson 14,003 13,937 13,886 -0.5% -0.4% 38.3 $57,487

63052 Imperial, MO Jefferson 26,225 27,106 28,112 3.4% 3.7% 35.9 $69,270

63109 St. Louis, MO St Louis City 26,920 26,473 26,076 -1.7% -1.5% 39.0 $59,185



63118 St. Louis, MO St Louis City 26,863 27,203 27,653 1.3% 1.7% 32.4 $42,568

63119 webster groves, MO St Louis 33,709 33,446 33,265 -0.8% -0.5% 41.5 $87,609

63122 kirkwood, MO St Louis 39,289 39,617 40,017 0.8% 1.0% 42.9 $108,143

63123 Affton, MO St Louis 49,160 49,299 49,578 0.3% 0.6% 42.0 $ 60,772

63125 Lemay, MO St Louis 32,352 32,411 32,554 0.2% 0.4% 41.7 $51,470

63126 Crestwood, MO St Louis 15,100 15,018 14,968 -0.5% -0.3% 45.0 $77,872

63127 Sunset Hills, MO St Louis 4,984 5,045 5,127 1.2% 1.6% 51.5 $108,048

63128 Sappington, MO St Louis 29,027 29,208 29,479 0.6% 0.9% 49.5 $ 86,856

63129 Mehlville, MO St Louis 52,930 53,681 54,648 1.4% 1.8% 42.8 $83,593

23 PSA zip codes 612,496 616,086 621,220 0.6% 0.8% 40.3 $68,882

APPENdIX I

25

Question 1Hello, my name is (insert name) from Communica- tions for Research, an independent market research firm and I’m conducting a survey today about health care in your area. We are only interested in your opin-

Question 2And which of these categories describes your age group? Are you: (aided – read off:)

x. Under 21 years old (if so – terminate) 1. 21 to 34 goal = 110 2. 35 to 44 goal = 93 3. 45 to 54 goal = 112 4. 55 to 64, or goal =8 7 5. 65 years and older? goal =9 8 9. Refused (if so – do not terminate)

Question 3In your opinion, what do you think is the biggest health care problem facing your community? (one response only – if not sure/refused skip to Q5)

0. None2. Obama Care (negative)3. Cost/money/expense4. No health insurance6. Insurance rates / premiums8. Co-pays / deductibles17. Cancer22. Prescription costs28. Obesity34. Lack of availability/access /not enough doctors98. Other (note: do not force into pre-coded responses – specify:)99. Not sure

ions on this subject; at no time will I try to sell you anything ... In what zip code do you currently live?

(unaided - if not on this list or refused or if they do not know – terminate)

Question 4And how well is that problem being addressed – by the health care resources that are available in your area? (aided – read off responses in order:)

1. Very well2. Somewhat well3. Not too well, or4. Not very well at all?9. (don’t ask:) Not sure / Refused

Question 5Does anyone in your household have a chronic illness or condition – that is an on-going medical problem? (if yes – ask:) What chronic illness or condition do they have?

(unaided – select all that apply) (probe if confused about the word chronic: “they still have it”)

0. None (if so – skip to Q7)99. Not sure (if so – skip to Q7) 1. Yes, but could not specify (if so – skip to Q7)3. Arthritis4. Asthma5. Cancer7. Diabetes8. Heart disease10. High blood pressure15. Other (specify:)

APPENdIX II

S. ST. LOuIS COuNTY N. JEFFErSON COuNTY S. JEFFErSON COuNTY / IL CITY OF ST. LOuIS MId ST. LOuIS COuNTY Zip Code Quota Zip Code Quota Zip Code Quota Zip Code Quota Zip Code Quota

63126 18 63051 10 62236 11 63109 21 63119 22

63127 6 63052 19 62298 15 63111 16 63122 25

63128 35 63049 12 63012 9 63116 33 63123 32

63129 62 63010 26 63020 18 63118 21 63125 21

total 120 63026 32 63028 23 total 90 total 100 total 100 63050 14

total 90

ST. ANTHONY’S COMMuNITY SurVEY SuMMArY

26

Question 10Which of the following – if any – do you consider to be a barrier to obtaining medical care for the people

who live in your household: (read and rotate parts – except those mentioned above in Q9) … would that be: a large barrier, a small barrier or no barrier at all?

Question 6And how confident do you feel – that you can do everything that is necessary – to manage this condi-tion of (insert each of those mentioned above – then read off scale for each:)

1. Very confident2. Somewhat confident3. A little confident, or4. Not at all confident?9. (don’t ask:) Not sure / Refused

Question 7In general, would you say that the condition of your health is: (aided – read off:)

1. Excellent2. Very good3. Good4. Fair, or5. Poor?9. (don’t ask:) Not sure / Refused

Question 8Do you have a doctor whom you see for regular check-ups? (if yes – ask:) About how long has it been since you last visited a doctor for a routine check-up or physical examination?

0. (don’t ask:) No regular doctor

1. Within the past 12 months (aided – read off these three responses only)2. One to two years ago3. Three or more years ago?4. (don’t ask:) Never had check-up9. (don’t ask:) Not sure / Refused

Question 9Over the past few years, have you – or any member of your household – faced any problems trying to get the medical care that was needed?

— (if no select code 0 – then go to Q10)

— (if yes – ask:) What kind of problems did your family face when trying to get medical care?

— (don’t read off responses – select all that apply)

0. No problems (if so –go to Q10)1. Have to travel too far2. Cost of care is too high3. Doctors not available at a convenient time4. Quality of care near (me) is not good5. Doctors not taking new patients6. Don’t have transportation7. Can’t afford cost of medicine8. Don’t have health insurance9. Health insurance would not cover it98. Other (specify:)99. Yes faced problems, but not sure what

(rEPEAT SCALE AS NECESSArY) uN-AIdEd LArgE SMALL NO BArrIEr (dON’T ASk) BArrIEr BArrIEr AT ALL dk

a. You have to travel too far 4 3 2 1 9

b. The cost of care is too high 4 3 2 1 9

c. doctors are not available at a convenient time 4 3 2 1 9

d. The quality of care near you is not good 4 3 2 1 9

e. doctors are not taking new patients 4 3 2 1 9

f. You don’t have transportation 4 3 2 1 9

g. You can’t afford the cost of medicine 4 3 2 1 9

h. You don’t have health insurance 4 3 2 1 9

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Question 11Do you engage in any physical exercise or sports activities – outside of your job?

— (if no write in 00 – or not sure write in 99 – and then go to Q12)

— (if yes – ask:) About how many minutes or hours do you exercise in a typical week?

____ ____ minutes (or) ____ ____ hours

Question 12AAbout how many times – in a typical week – do you eat the following foods: (read and rotate – if none write in “00” – if not sure write in “99”)

___ ___ a. Fruits ___ ___ c. Fried foods

___ ___ b. Vegetables ___ ___ d. Soda (non-diet)

Question 12BAbout how many times have you – personally – eaten at a fast-food restaurant in the past month? (if none write in “00” – if not sure write in “99”)

____ ____ times in past month

Question 13Have you used any tobacco products in the past 12 months?

— (if no select “0” or if dk select “9” – and then go to Q14)

— (if yes– ask:) And which of the following tobacco products have you used in the past 12 months? (read first six in random order, select all that apply)

1. Cigarettes

2. E-cigarettes or vapes

3. Pipes or cigars

4. Nicotine patch or gum

5. Chewing tobacco

6. Snuff

8. Or any other form of tobacco? (specify:)

0. (don’t ask:) No tobacco products (if so, go to Q14)

9. (don’t ask:) Not sure / refused (if so – go to Q14)

Question 14Thinking about the people who live in your com-munity, do you know anyone personally who has any of the following medical problems? (rotate codes 2, 3, 4 only – select all that apply)

1. A heart condition

2. Substance abuse with drugs or alcohol

3. Diabetes

4. Mental health issues

0. (don’t ask:) None of these

Question 15Do you have some form of insurance that covers a portion – or all – of your health care expenses?

— (if no – check 0 and go to Q16) (if yes – ask:)

What type of health insurance do you have? (read off not rotated – multiple responses OK)

0. (don’t ask:) No health plan

1. a health plan, such as Blue Cross or United, which you – or your company – pays

2. Medicare

3. Medicaid, or …

4. Some other type of plan? (specify)

7. (don’t ask:) Yes, but can’t remember which

9. (don’t ask:) Not sure / Refused

Question 16These next few questions are for classification purposes only …

What is the highest grade – or year – of school that you have completed?

08. Grade school (0-8) (read off – if necessary)

11. Some high school (9-11)

12. High school graduate or GED (12th)

13. Some college or technical school (1-3 years)

16. College graduate (4 or more yrs.)

18. Graduate or professional degree

99. (don’t ask:) Refused / not sure

28

1. Health Care Issues

Q3. “In your opinion, what do you think is the big-gest health care problem facing your community?”

• While financial issues are still the biggest concern by a large margin (53%), there has been a statisti-

NEEdS ASSESSMENT SurVEY – 2015 – kEY FINdINgS

cally significant shift towards “cost” (36%) as the biggest health care problem and away from insur-ance (“no insurance” and “cost of insurance”). Health care reform (ACA) is also a bigger prob-lem this year, although the change from 2012 is not significant.

Question 17Which of the following categories – does your household’s annual income – fit into:

1. Under $25,000 per year (read responses in order)

2. Between $25,000 and $50,000

3. $50,000 to $75,000

4. $75,000 to $100,000

5. $100,000 to $125,000, or

6. More than $125,000 per year?

9. (don’t ask:) Refused / not sure

Question 18And finally … in your opinion, what can hospitals be doing to improve your health – and the health of the people in your community? (allow multiple responses)

(if “lower costs” ask – “Is there anything other than lowering costs?”)

THANK RESPONDENT AND TERMINATE

Question 19(don’t ask:) Respondent’s gender: (no quotas)

1. Male 2. Female

Question 20(don’t ask:) Sample

1. Wireless (quota: n=175-200) 2. Landline

* Base: n=500 (2012) / n=500 (2015).

29

• Those who say that health care cost is the biggest problem are less likely to have a primary physician who they see regularly – and they also tend to ex-ercise more often. However, the respondents who say that insurance (cost or the lack of) is their biggest concern are more likely to have a regular PCP.

• Cost is a greater issue in South County (58%), while a lack of access to health care or physicians is mentioned more often in southern Jefferson County and the two Illinois zip codes (14%). In addition, residents in the southern part of the City of St. Louis are more likely to report that illness is the biggest problem.

• Lack of access to health care or physicians is an important issue overall (9%), but it’s significantly more impactful in the southern part of Jefferson County and the two zip codes in Monroe County, IL (14%).

Those who cannot cite a specific problem (19%) are more likely to be:

— On Medicare— 65+ (but also <35)— Perform no exercise— Have no college education

Q4. “And how well is that problem being addressed by the health care resources that are available in your area?”

• There has been some significant changes in how well health care problems are being addressed. The percentage reporting that these problems are being addressed “very well” has been halved since 2012 (from 11% to 5%) and the percent-age who say problem resolutions are going “not well at all” have increased dramatically (from 34% to 47%).

BIggEST HEALTH CArE PrOBLEM

S. STL County N. Jeff County S. Jeff County / Il City of St. Louis Mid STL County Overall

PCT PCT PCT PCT PCT PCT

Cost 41 43 32 28 35 36

No insurance 10 5 8 13 11 9

Insurance cost 7 7 7 7 7 7

sub-total cost 58 55 47 48 54 53

ACA 8 10 12 7 10 9

Lack of access / doctors 6 7 14 11 7 9

Illnesses 5 5 1 9 6 5

None mentioned / not sure 18 16 21 19 19 19

Others * 6 7 6 6 4 6

total 100 100 100 100 100 100

Base (n=) 96 112 86 94 112 500

* Others: Financial problems, Medicare problems (1%); need more information, patient compliance, flu shots, un-necessary procedures, slow claims processing, don’t understand insurance, industry corruption, inequality (<1% each). Significantly higher indicated by a red box.

30

• “Lowering cost” (22%) is the most popular response to “what (can) hospitals be doing to improve” health care, followed by “improving the quality” (14%). These top two responses are the same that were given in the 2012 survey (which specified SAMC in the question).

HOw wELL PrOBLEMS ArE BEINg AddrESSEd

Problem Illness No Insure Lack of Access Cost Insure rates ACA Overall

PCT PCT PCT PCT PCT PCT PCT

Very well 26 7 5 4 0 0 11

Somewhat well 24 30 29 28 17 7 30

Not too well 27 33 35 24 18 18 26

Not well at all 24 30 31 45 65 76 34

Total 100 100 100 100 100 100 100

Mean score * 2.50 2.14 2.07 1.90 1.52 1.32 1.87

Base (n=) 24 41 41 169 36 43 382

* Calculated from this scale: very well=4; somewhat well=3; not too well=2; not well at all=1. The higher the score, the better problems are being addressed. Note: low base for many problems.

• Significantly worse indicated by a red box.

• The respondents who are having the most trouble getting their health problems adequately addressed are the same people who are at risk:

— No primary physician

— No exercise at all

— Live in Jefferson County or Illinois

— Older (mostly seniors)

— Less educated (HS or less)

— Lower income (<$50K/yr).

• By examining which specific problem is the hard-est to address, we can see that reports of increasing insurance rates after the introduction of the ACA, as well as the law itself, is at least partially respon-sible for the worsening of problem resolution.

Q18. “In your opinion, what can hospitals be doing to improve your health and the health of the people in your community?”

* Base: n=339 (2012) / n=383 (2015). Only respon-dents who reported a health care problem.

31

• Cost, which also includes the cost of insurance, is mentioned relatively more often by younger people (especially those 35 to 44), people in good or bet-ter health and those who exercise more frequently (especially 7+ hours per week).

• Those seeking to improve the quality of care (which includes better care, diagnosis, doctors and hospitals) are more likely to be in fair or poor health, but yet they exercise quite a lot (3-6 times a week).

• The respondents who suggested all other improve- ments (outreach programs, faster services/ER wait time, low-income financial help and better access to care) tend to lack confidence that they can manage their condition, are under 65 years old and have completed at least some college.

2. Personal Health Conditions

Q5. “Does anyone in your household have a chronic illness or condition that is an on-going medical problem? What chronic illness or condition do they have?”

• The respondents who live with someone with a chronic illness or condition are more likely to be in fair or poor health themselves and have no primary physician. However, this group’s age (more 45 years+) and education profile (less than a graduate degree) does not indicate a population that is necessarily at risk.

• Endocrinology (10%) is the largest category of illnesses, which consists of mostly diabetes (8%),

• Three-sevenths of the population have someone in their household with a “chronic illness or condition” (38%), which is higher than what was recorded in the 2012 survey when the respondents were asked about their own condition only (31%).

followed by cardiology and other heart conditions, which consists mostly of high blood pressure (4%) and heart disease (3%).

• Other large clinical categories include: orthopedics (5%, mostly back/spine problems and arthritis); pulmonary (4%, mostly asthma); neurology (4%, memory issues, seizures, brain disease/injury); and oncology (3%, mostly cancer). A table showing all illnesses/conditions may be found in the Appendix.

* Question changed for 2015 survey. See Appendix for verbatim responses. Base (n=500).

* Others: Mental health (2%); gastroenterology, developmental, allergies, glaucoma (1%); liver disease, chronic pain, migraines, kidney disease, lymphedema, bone disease, skin disorders, sarcoidosis (<1% each); illness not specified (4%). Base (n=500).

32

• Because the small sample of households with any one condition, it is impossible to ascertain which conditions are easier to manage. In addition, there appears to be no statistically significant differences by geographic area, although we can determine that the following groups tend to be less than “very confident” about their ability:

— In fair or poor health

— Medicaid or no health plan

— Tobacco users

— 21 to 34 years old

— High school or less education

— Household income <$50K / year

• While most in fair or poor health fit the profile of those likely to be at risk, one outlier is that people with no primary physician actually tend to be in better health, most likely because they are younger. These groups have a personal health condition that is significantly lower than the overall population:

— Medicare patients (because of age) — Medicaid patients (or no health plan) — Tobacco users — Never exercise — Jefferson and Monroe County residents — Older (especially 65+) — High school or less education — Household income <$50K / year

Q6. “And how confident do you feel that you can do everything that is necessary to manage this condition?”

• It appears that the community now has much less confidence that they can “manage (their) condi-tion.” However, there is one crucial difference: this year we asked about a condition of “anyone in your household,” while the previous survey asked if “any doctor ever told you that you have” a condition.”

Q7. “In general, would you say that the condition of your health is …”

• The general health condition of the population has declined just a small amount over the past three years, and none of these changes are statistically significant. Now 12 percent of the respondents report that that their health is either “fair” or “poor,” compared to the entire state (18%) and the St. Louis area (17%), according to BRFSS data.

* Base: 2015 (n=211); 2012 (n=157). * Base: n=500 (2012) / n=500 (2015).

33

• While nearly nine percent of our sample report having diabetes in their household and the BRFSS data show that almost ten percent of the St. Louis area population has it, more than half of our respondents know someone with this disease (56%).

• On the other hand, almost half of the respondents know someone with heart disease (46%), which is only a little higher than the national incidence (34%), according to the American Heart Associa-tion’s 2014 Heart Disease and Stroke Statistics.

• The presence of mental health issues is not a secret, with two-fifths reporting that they know some-one with this disease (40%). This compares to 19 percent of the population that suffer from mental illness, according to the National Survey on Drug Use and Health.

• Substance abuse is the least socially-connected illness with only 32 percent of the respondents knowing someone with this illness, even though nine percent of the adult U.S. population suffer from it – according to the National Survey on Drug Use and Health.

• Because people are more likely to know others in their own geographic area, this measure is a good indicator where these illnesses are relatively more prevalent. The following chart shows that there is a greater prevalence of diabetes and substance abuse in south Jefferson and Monroe counties.

Q14. “Thinking about the people who live in your community, do you know anyone personally who has any of the following medical problems?”

• While the incidence of any specific medical problem may be low on an individual basis, when community members are asked if they “know anyone personally (with these) medical problems,” it is clear that these diseases touch many people. Less than one-third of the respondents (30%) do not know anyone with one of these problems.

* Base (n=500).

PrEVALENCE OF MEdICAL PrOBLEMS

Medical Issue S. STL County N. Jeff County S. Jeff County / Il City of St. Louis Mid STL County Overall


diabetes 55 46 69 53 57 56

Heart condition 44 43 52 43 49 46

Mental health issues 38 34 39 46 41 56

Substance abuse 22 33 44 30 32 32

Sub-total (unduplicated) * 62 69 78 67 74 70

None of these 38 31 22 33 26 30

Total 100 100 100 100 100 100

Base (n=) 96 112 86 94 112 500

* sub-total medical problems removes duplicates. Significantly higher indicated by a red box.

• People with higher levels of education are more likely to know someone with these illnesses, which indicates that less educated people either do not tell their friends about their health, or many of these illness remain undiagnosed.

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• Almost three-fourths of this years’ sample (73%) say they have had a check-up within the past 12 months, which is slightly higher than statewide (67%) and in the St. Louis area (71%). The remain- der (11%) report that they have a primary care physician, but have not a check-up within the past 12 months. These groups are more likely not to have a PCP:

— In excellent health — Medicaid patients (or no health plan) — Tobacco users — North Jefferson County residents — Younger (especially age 21 – 34) — High school or less education — Household income <$50K / year — Men (more than twice as likely)

3. Health Care Utilization

Q8. “Do you have a doctor whom you see for regular check-ups? About how long has it been since you last visited a doctor for a routine check-up or physical examination?”

• There has been a slight (but not significant) rise in the percentage of community members who do not have a primary care physician (17%) compared to 2012 (12%). However, this incidence is still less than the percentage statewide (21%) or in St. Louis area (19%), according to BRFSS data.

Q9. “Over the past few years, have you – or any member of your household – faced any problems trying to get the medical care that was needed? What kind of problems did your family face when trying to get medical care?”

Q10. “And which of the following if any do you consider to be a barrier to obtaining medical care for the people who live in your household?

Would that be a large barrier, a small barrier or no barrier at all?”

• There are only three major problems – mentioned by the respondents unaided – as being an issue when they are “trying to get medical care”: the “cost of care is too high” (4%); I “can’t afford cost of medicine” (3%); and “health insurance would not cover it” (3%)

* Base: n=500 (2012) / n=500 (2015).

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• These groups are more likely to report having a large barrier to care:

— In fair or poor health (all barriers, especially transportation and cost of medication)

— No primary (especially cost of care, quality of care, medicine cost, no health insurance)

— Tobacco users (cost of care, no transportation, cost of medicine, no health insurance)

— Medicaid / no insurance (all barriers except doctor not available at convenient time)

— Under 65 years old (cost of care, doctor not available at convenient time, med. cost)

— No college degree (all except travel too far, doctor not available at convenient time)

— Household income <$50K / year (all except doctor not available at convenient time

• When a follow-up question asks the respondents to quantify how large a barrier these problems are, it becomes clear that cost (as in “cost of care is too high”) is by far the biggest barrier. A solid majority say this is some sort of barrier (62%) and 38 percent consider it a “large” barrier or actually mention it on an unaided basis.

• On the other hand, convenience issues, such as I “don’t have transportation” (81% say no barrier) and I “have to travel too far” (75%), are the least problematic. The other five situations are a large (or unaided) barrier for between 17 and 23 per-cent of the sample.

• While most of the barriers to receiving care have grown significantly larger since this survey was conducted in 2012, the addition of the unaided question is likely to have ‘framed’ the respondents’ answers and exaggerated the perception of barriers.

• Cumulatively, 14 percent of the respondents report at least one barrier to receiving care (after remov-ing duplications) and there are some statistically significant differences by geographic area. The people in southern Jefferson County plus IL (24%), the City of St. Louis (17%) and northern Jefferson County (16%) are facing more barriers.

* Base (n=486-499). Note: “health insurance would not cover it” was not asked as a follow-up question

* Percentage reporting a barrier to care unaided or a “ large” barrier.

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• The people who are on a managed care health plan fit the profile of someone who is still in the work-force (under 65 years old) and less at risk:

— In better than fair or poor health

— Does not use tobacco products

— Exercises moderately (3 to 6 hours/week)

— Earns more than $50K/year

• Those on Medicare are mostly (and not surprisingly) older 65+ and are more likely to:

— Be in fair or poor health

— Had a recent check-up with a primary

— Have a high school education or less

— Earn less than $50K/year

• The respondents with no coverage or on Medicaid are more likely to:

— Be in fair or poor health — Have no primary or regular check-up — Use tobacco products — Do little exercise or a lot of exercise — Be 21 to 34 years old — Earn less than $50K/year — Be male

• Health insurance coverage shows some significant differences by geographic area, with those living in southern Jefferson or Monroe counties more likely to have a managed care plan (78%). Those who live in northern Jefferson County (20%) or the City of St. Louis (21%) are more likely to have no coverage at all or be on Medicaid.

* Base: (n=500). Significantly higher indicated by a red box

• There has been a shifting away from managed care plan since the 2012 survey (76%) to the 2015 survey (69%), although this difference is not quite sta-tistically significant. This apparent loss of private health plan coverage has shifted to Medicare (+2%), Medicaid (+2%) and no coverage (+2%) – and these changes are also not significant.

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• These groups tend to engage in more exercise:

— In excellent or very good health — All areas except City of St. Louis — More education (especially grad degree) — Higher income (especially $100K+) — Men

• These groups tend to engage in no exercise at all:

— In poor or fair health — On Medicare or Medicaid — Have no health plan — High school education or less — Household income <$50K per year

* Base: n=500 (2012) / n=500 (2015).

4. Personal Health Habits

Q11. “Do you engage in any physical exercise or sports activities outside of your job? About how many minutes or hours do you exercise in a typical week?”

• The amount of exercise reported by respondents has

Q12a. “About how many times – in a typical week – do you eat the following foods?”

Q12b. “About how many times have you personally eaten at a fast-food restaurant in the past month?”

increased 14 percent since 2012 (from 3.0 to 3.4 hours per week). However about the same percentage are not exercising this year (29%) compared to 2012 (30%), and both are a little higher than the percentage statewide (28%) and in the St. Louis area (26%), according to 2013 BRFSS data.

• While food consumption, like exercise compliance, may be subject to a degree of exaggeration, we find that respondents report eating healthful foods (fruits and vegetables) – on average – three to four times more often than some of the foods that are less healthy (fried foods and non-diet soda).

TIMES PEr wEEk FruITS VEgETABLES FrIEd FOOdS SOdA (NON-dIET) FAST FOOd*

PCT PCT PCT PCT PCT

None 2 1 20 56 16

Once 3 1 32 10 48

2 to 3 16 11 33 12 26

4 to 5 22 21 11 6 8

5 to 7 32 40 3 12 1

8 to 14 16 17 1 2 1

15 plus 9 10 0 2 0

Total 100 100 100 100 100

Mean times 7.5 7.9 1.9 2.6 1.2

* Converted from monthly to weekly. Base: (n=500).

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• Almost 17 percent of this sample eat fruit at least 14 times a week (or twice a day), much less than the rate that BRFSS reports for the entire state (25%) or for the St. Louis area (28%). However, the BRFSS survey asks about consumption per day – rather than per week – which is likely to encourage their respondents to over-report.

• These groups tend to consume fruit less often:

— Lower health condition (less than very good)

— Medicaid or no insurance

— Tobacco users

— No exercise

— Less than a college degree

— Earn <$100K per year

— Men

• Our survey found that only five percent of respondents eat vegetables at least three times per day, much lower than Missouri (13%) and the St. Louis area (13%), according to BRFSS data. These groups tend to consume vegetables less often:

— Medicaid or no insurance

— Tobacco users

— Less exercise (especially none)

— Reside in north Jefferson County

— Less than a college degree


— Men

• Four-fifths of our sample (80%) avoid fried foods altogether, while the average respondents eats fried food nearly twice a week (1.9). These groups tend to consume fried foods more often:


— Tobacco users

— No exercise

— Age 21 to 34

— No college degree

— Men

• Non-diet soda consumption is – on average – a little higher (2.6 times/week), although more than a majority of the respondents avoid these drinks altogether (56%). About 15 percent consume non- diet soda at least once a day, compared to 17 percent for all Missourians, according to BRFSS data. These groups tend to consume soda more often:

— Excellent and fair/poor health

— No regular check-ups

— Medicare patients

— Tobacco users

— No exercise

— Age 21 to 34


— Men

• Fast food usage is the lowest of all, with an average ate of a little more than once a week (1.2). Only 36 percent eat fast food more than once a week, which matches up well with data from a national 2013 Gallup survey. These groups tend to eat fast food more often:


— Tobacco users

— Reside outside of St. Louis County

— Under 45 years old

— Some college or technical degree

— Men

Q13. “Have you used any tobacco products in the past 12 months? And which of the following tobacco products have you used in the past 12 months?”

• Overall tobacco usage (18%) has barely changed since our 2012 survey (17%). BRFSS data show

that the incidence of cigarette smoking in the state (22%) and the St. Louis area (21%) is much higher than the 15 percent found in our survey. However, the BRFSS survey was fielded before e-cigarettes became popular (now at a 4% usage rate).

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* Base (n=500). “Any” is the accumulation of all usage after removing duplications.

• Smokeless tobacco, which combines chewing and snuff is used by 2.6 percent of the population, which is about the same as the St. Louis area (2.4%, according to BRFSS data), but much lower than all of Missouri (5.2%).

• These groups are more likely to use any to-bacco product:

— No primary physician — Medicaid or no insurance — Under 35 years old

— High school grad or less


— Men

• Tobacco usage varies significantly by geographic area, with the greatest incidence in northern Jefferson County for cigarette smoking (26%), pipes/cigars (6%) and overall tobacco usage (30%). The two areas entirely in St. Louis County have the lowest overall usage rates: Mid County (10%) and South County (10%).

TOBACO PrOduCT uSAgE

Type of Tobaco Product S. STL County N. Jeff County S. Jeff County / Il City of St. Louis Mid STL County Overall


Cigarettes 11 26 12 17 7 15

E-cigarettes 1 6 7 3 5 4

Pipes / cigars 0 6 0 4 5 3

Chewing tobacco 1 5 6 0 0 2

Snuff 0 2 0 0 0 0.4

Nicotine patch/gum 0 1 0 0 0 0.2

Sub-total (unduplicated)* 12 30 17 20 10 18

None 88 70 83 80 90 82

Total 100 100 100 100 100 100

Base (n=) 96 112 86 94 112 500

* sub-total tobacco usage removes duplicate product usage. Significantly higher indicated by a red box.

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Q16. “What is the highest grade or year of school that you have completed?”

• St. Louis County residents have completed more years of education (14.7 years) than those who live in Jefferson County (13.8 years). More than two-fifths of the respondents from northern Jefferson County have no more than a high school diploma (41%), which is almost double the percentage found in St. Louis County (24%).

Q17. “Which of the following categories does your household’s annual income fit into?”

• St. Louis City residents have the lowest median household income ($47K/year), while those in South County are the wealthiest ($83K/yr). People with annual household incomes below $25,000 are found much more often in the City (27%) than in South County (only 1%).

Q19. Respondent’s Gender

• The overall sample is more female (56%) than male (44%) because women are more likely to make health care decisions for their households – and they are generally more like to be cooperative in a telephone interview. There are no significant differences by geographic region.

Q2. “And which of these categories describes your age group? Are you … “

• Mid-County residents are older (median 53 years) than the typical respondent (50 years). The differences between the geographic areas are most notable with seniors: Mid-County consists of 30 percent seniors compared to only 20 percent overall. The youngest area is the City of St. Louis (median 47 years), which has relatively fewer seniors (only 11%).

* Base: (n=495).

* Base: (n=500).

* Base: (n=442).

* Base: (n=498).

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Q1. What is the biggest health care problem facing our community and the patients you serve?

ANSwEr OPTIONS rESPONSE COuNT

diabetes/Obesity/Lifestyle 16

Cost/Insurance 15

Mental Health 7

Access 6

43 answered the question 0 skipped the question

Q3. In your opinion, how much of a problem is substance abuse, including drugs and alcohol abuse, in our community?


A big problem 26

Somewhat of a problem 16

A minor problem 2

Not a problem at all 1


Q2. How well is the health care problem that you indicated previosly being addressed by the health care resources that are available in our area?


Very well 0

Somewhat well 14

Not too well 24

Not very well at all 5


APPENdIX III

PHYSICIAN SurVEY rESuLTS

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Arthritis 7

Asthma 1

Cancer 2

COPd or Lung Cancer 7

diabetes 18

Heart disease 10

High Cholesterol 8


Lack of motivation/accountability 17

Cost 21

Access 5

Q4. Of the chronic illnesses or conditions that you see in your patients, which chronic disease or condition do you feel is the most prevalent?

Q5. What do you feel is the biggest barrier to a patient being able to manage their chronic disease or condition?


High Blood Pressure or Hypertension 15

kidney disease 3

Osteoporosis 0

Obesity 26

Anxiety or depression 16

Other (please specify) 3



Lack of support 8

Education 8

Mental health stigma 1


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Alcohol abuse 16

drug abuse 22

Asthma 3

Cancer and/or other preventative screenings 11

diabetes education 22

Q6. Please select the types of health education services most needed by the patients in our community:


diet/exercise education 35

Smoking cessation and/or prevention 21

Mental health 27

Other (please specify) 3


Q7. What can a hospital, like St. Anthony’s Medical Center, do to help improve the health of your patients and others in the community?


wellness/Education 22

Advertise — get patients in earlier 7

reimbursement for free care 6

Free screenings/Flu shots 4


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kEY STAkEHOLdEr ANALYSIS

NAME OrgANIZATION ATTENd

1 rachelle Bartnick American Heart Association x

2 Mindy Bielik St. Louis Suburban School Nurses x

3 damon Broadus American Heart Association x

4 gloria Brown Missouri House of representatives x

5 Thomas duff Catholic Family Services x

6 dan duncan National Council on Alcoholism & drug Abuse x

7 Beth Elders Manchester united Methodist Church x

8 diane Mckenna South County Health Center x

9 Maggie Menefee ALIVE x

10 dominic Moll Lemay Fire Protection district x

11 Mattie Moore Office of the County Executive x

12 dianne Mueller St. Louis Crisis Nursery x

13 wendy Orson Behavioral Health Network x

14 Mary Schaefer Mid-East Area on Aging x

15 Spring Schmidt St. Louis County dOH x

16 kelly Shouse Hope Lodge

17 rikki Takeyama regional Health Commission x

18 Cathy Vaisvil united way 2-1-1

19 Ted west Feed My People x

20 katie wren American Cancer Society x

21 Anna Zelinske Jewish Community Center x

22 Lottie wade united way x

23 Vickie wade People’s Health Centers x

24 denise wiehardt Crisis Nursery x

APPENdIX IV

HOSPITAL ATTENdEES

1 Marci Allen MBMC

2 Jennifer Arvin BJwCH

3 Laura Bub SAMC

4 Christine Candio St. Luke’s Hospital

5 Joan Elkins MBMC

6 Yoany Finetti BJwCH

7 Madeleine gemoules Mercy St. Louis

8 dennis Holter SAMC

9 Jeff Johnston Mercy St. Louis

10 Liz kalicak BJwCH

HOSPITAL ATTENdEES CONTINuEd

11 karley king BJC HealthCare

12 Sharon Neumeister Mercy St. Louis

13 Jim LaChance BJwCH

14 Tara Osseck St. Luke’s Hospital

15 Lisa Stringer BJC HealthCare

16 Ann Varner Mercy St. Louis

17 debra Victor MBMC

18 Angela wade BJC HealthCare

19 Josh waite Mercy St. Louis

20 Cindy weinstein BJwCH

21 darla wertenberger St. Luke’s Hospital

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Background

The Patient Protection and Affordable Care Act (PPACA, March 2010) requires that non-profit hospitals conduct a community health needs assessment (CHNA) every three years. As part of that process, each hospital is required to solicit input from those who represent the broad interests of the community served by the hospital as well as those who have special knowledge and expertise in the area of public health.

In 2012, several hospitals collaborated on their first needs assessment, with a specific focus on west and south St. Louis County. They included Barnes-Jewish West County Hospital (BJWCH), Missouri Baptist Medical Center (MBMC), St. Anthony’s Medical Center (SAMC) and St. Luke’s Hospital (SLH). In 2015, they were joined by Mercy St. Louis in this collaboration.

Each of the hospitals is at a different phase in the assessment process and is on different implementa-tion plan timetables. SAMC and Mercy made their plans public in June 2013, while the BJC hospitals and St. Luke’s were made public in December 2013. The next iteration of CHNA plans will be due on the corresponding months in 2016.

All of the hospitals are in the process of preparing their next CHNA, and agreed to continue their collaboration to assess feedback from community stakeholders who have an interest in the health of consumers in West and South St. Louis County.

Research Objectives

The main objective for this research is to solicit input from healthcare experts and those who have a special interest in the healthcare needs of St. Louis County residents, especially those in the west and south, who are served by these five hospitals. Specifically, the discussion focused on the following objectives:

1. Determine whether the needs identified in the 2012/2013 CHNAs are still the right areas on which to focus

2. Explore whether there are there any needs on the list that should no longer be a priority

3. Assess where there are the gaps in the plans to address the prioritized needs

4. Identify other organizations with whom we should consider collaborating

5. Discuss how the world has changed since 2012/2013 when the participating hospitals first identified these needs, and whether there are there new issues they should consider

6. Evaluate what issues the stakeholders anticipate becoming a greater concern in the future that we need to consider now

Methodology

To fulfill the PPACA requirements, BJWCH, MBMC, SAMC, SLH, and Mercy St. Louis hosted a single focus group with public health experts and those with a special interest in the health needs of residents located in west and south St. Louis County. It was held on July 23, 2015 at the Frontenac Hilton in St. Louis County. The group was facilitated by Angela Ferris Chambers, Manager of Market Research & CRM for BJC HealthCare. The session lasted ninety minutes.

19 individuals representing various St. Louis County organizations took part in the discussion. Two others were invited, but were unable to attend (Appendix A).

Christine Candio, President and CEO, St. Luke’s Hospital, welcomed participants at the beginning of the evening. Those who were observing on behalf of Barnes-Jewish West County Hospital, Missouri Baptist Medical Center, St. Anthony’s Medical Center, St. Luke’s Hospital, and Mercy St. Louis introduced themselves to the group (Appendix A).

During the group, the moderator reminded the community leaders why they were invited - that their input is needed to help each hospital move forward in this next phase of the needs assessment process.

The moderator shared the needs prioritized by each hospital in the first assessment and discussed where each hospital is in its implementation plan. She also mentioned that several hospitals are working to stan- dardize the language for identifying prioritized needs

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so that impact can be measured consistently. This will allow the sharing of best practices among all facilities. The five hospitals identified several priorities for the 2012/2013 CHNAs, ranging from access to health

Further, each hospital outlined goals and tactics for implementation to be used in measuring the success of each priority. Details of each hospital’s needs assess-ment plan can be found on each hospital’s website.

BJWCH, MBMC, SAMC, SLH, and Mercy St. Louis agree that the following needs are important, but chose not to address them in 2013:

• Alcohol/Substance Abuse• Cultural Literacy• Maternal and Infant Health• Senior Services/Social Support

After the discussion, participants were asked to rate each need on their level of concern, as well as the ability to address them via community collaboration.

Perception of 2012/2013 Priorities:

There was general consensus that the priorities identified in the previous assessment are still those on which the hospitals should focus. Further, goals and tactics discussed provided some insight into the detailed CHNA implementation plans that are

insurance coverage to violence. Although some needs varied, they share overall priorities such as access to services, cancer, and to some degree, chronic diseases and behavioral/mental health:

located on BJWCH, MBMC, SAMC, SLH, and Mercy St. Louis websites.

Consideration For Adding To The Priority List:

After reviewing the hospitals’ key issues/priorities, nothing was identified that should come off the list. Many expressed the desire to reevaluate the priorities, however, and integrate additional needs into the list of those being addressed.

• Alcohol/Substance Abuse: Incidence rates have risen substantially over the years, especially for heroin and prescription drugs, and are considered a “major public health issue.” At the same time, fewer treatment services are available, especially inpatient beds. Further, limitations on insurance plans and reimbursement contribute to the slow demise of medical-assisted treatments, detox pro-grams, and other services required to treat those who struggle with addiction.

• Senior Services/Social Support: The senior population is increasing, particularly in South County. Seniors are large consumers of services, with unique

BJwCH MBMC ST. ANTHONY’S ST. LukE’S MErCY ST. LOuIS

• Access to coverage • Access to services • Access to services • Cancer: breast • Access to coverage

• Chronic disease: • Cancer: breast • Behavioral/ • Cancer: colon • Access to services Heart and vascular Mental health

• Cancer: skin • Cancer: skin • Health literacy • Cancer: lung • Behavioral/ Mental health

• Chronic disease: • Chronic disease: • Tobacco use diabetes diabetes

• Chronic disease: • Chronic disease: • Violence: Heart and vascular Heart and vascular domestic and family

• Obesity

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needs currently not being addressed. Several agree that access to transportation is a major concern for them. Often, it is difficult for seniors to get to the hospital or to their primary care physician

because they do not drive. As a result, “they end up calling the emergency group because they don’t have transportation.”

• Maternal/Child Health: St. Louis County has a high infant mortality rate and it is getting worse.

Consideration should also be given to redefining the following category:

• Senior Services/Social Support: Social support should be separated from senior services as an area of need. Social support is important not just for Seniors but to women, children and families, and each may require a different approach.

Gaps In Implementation Strategies:

Although nothing was identified that should come off the list of prioritized needs, there were gaps identified in the ways in which needs are being addressed.

Alcohol/Substance Abuse:

• Other states have adopted prescriber guidelines and tool kits that have resulted in demonstrable decreases in opioid abuse and heroin deaths.

• Providers who are treating patients with chronic conditions have an opportunity to provide ad-ditional referrals to those who are also dealing with substance abuse and/or mental health issues. Addressing the latter would increase the likelihood of the patient being more compliant in dealing with his/her chronic condition.

• There is a need to address the stigma associated with both substance abuse and behavioral health issues by examining the language used to talk about them and the processes put into place for users to access services. If barriers to access could be lowered as well as the stigma that these systems create, more people might take advantage of the services that do exist.

Behavioral/Mental Health:

• There is increasing awareness that trauma affects an individual’s mental health. The impact that Ferguson has had on our community as well as environmental trauma, in general, needs to be acknowledged.

• Physicians need a greater awareness of how to identify mental health issues, and when to refer individuals for counseling and mental health services. People will follow the recommendations of those whom they trust, including their physicians.

• There is an insufficient number of child psychi-atrists in the area compared to the size of the need. Medicaid reimbursement is inadequate to encourage local psychiatrists to participate in the program.

• A resource the region doesn’t have is access to Crisis Respite for individuals undergoing a mental health crisis. This would be a place where an individual could get some additional support, get stabilized and then return to the regular routine of their life.

• Resources to support mental health are not sufficient. Mental health should be treated no differently than cancer.

• There’s no good system within the region to share health information in an appropriate way. An individual who has been on a stable medication regimen but stops taking them needs to get back on their treatment plan. If s/he comes into the ED, there’s no way to know that, however, and their medications are changed. They may never get back to that level of recovery.

Chronic Conditions:

• When hospitals perform screenings, there needs to be a mechanism in place for those with positive results to receive follow-up care, especially if they don’t have insurance. How do we address the needs of those who are diagnosed but are unable to access treatment?

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Colon Cancer:

• 70% of those not being screened for colon cancer have health insurance. Primary care physicians need to encourage their patients to be screened, and address the fear and stigma that may be preventing them from following through.

Health Literacy:

• Health literacy and cultural literacy should be considered a component of every program, and not as “stand-alone” needs. For every need that is defined, the approach should be evaluated with an eye to both health literacy and cultural literacy.

CHANgES SINCE 2012/2103 ANd NEw ISSuES OF CONCErN:

Access To Transportation:

• Having transportation available to access medical services is a major concern. Without it, individuals end up using emergency medical transportation inappropriately, making it unavailable for some-one who truly may need it and increasing health care costs unnecessarily.

• Thinking creatively in our approach, there are opportunities to bring services into the community where they are needed, rather than forcing the population to go to the services. Consider expanding the concept of a mammography van to a vision van, a heart & vascular van, or a van that visits schools to provide pediatric care.

• Some communities have also created programs that use paramedics to make “house calls” to individuals who might not otherwise have access, eliminating their use of emergency services unnecessarily.

• The state Medicaid transportation program is both inefficient and ineffective.

Collaboration:

• Many expressed a desire to explore opportunities to collaborate on these issues more than every three

years. Those sitting at the table would like to be included in the process, and seek opportunities to work with these hospital partners to expand every- one’s reach. In addition, there is an opportunity to engage faith communities that are easily acces-sible to each of the hospitals and invite them to be involved in the process. Other partners might in-clude urban housing groups, the County Health Department and the City Health Department.

• There are other non-traditional health partners to consider as well as community organizations like Oasis through which collaboration would encourage the breaking down of silos and promote a more community-based approach.

Maternal/Infant Health:

• Recent statistics indicate that health outcomes for infants are worse in St. Louis than in some third world countries. Children are more likely now than ever to be killed at the hands of a caregiver.

Health Disparities:

• Individuals will experience vastly different health outcomes based on characteristics such as race, age, gender or where they live in St. Louis. Health disparities should be considered within every need that is identified and addressed in the hospitals’ plans.

• The report For Sake of All by Dr. Jason Purnell of the Brown School of Social Work at Washington University should be referenced to better under-stand the role of health disparities in St. Louis.

Cultural Literacy:

• Cultural literacy directly impacts quality of care, continuity of care, and health outcomes. Further, it is believed that achieving implementation goals outlined in the hospitals’ CHNAs hinge upon the partners’ ability to increase cultural competencies and lower barriers. If the barriers are lowered by increasing cultural literacy, more people may take advantage of new or existing services.

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Social Determinants Of Health:

• The escalation of violence in the last three years has affected every community, not just north St. Louis. It has an impact on mental health and also feeds into substance abuse.

• Access to health insurance through Missouri Health Net was once a two-month process. Now, due to the Affordable Care Act, it takes six to nine months.

• Individuals of every age have a need for social support. Caregivers of those with health issues struggle to provide care to their loved one and serve as the link between them and the agencies from which they obtain services. There is a need for services that educate and support the caregivers, so they can maintain their loved one at home.

Childhood Obesity:

• This issue is a growing concern, and will impact the incidence of chronic conditions as these children grow into adulthood.

Other areas of concern, briefly mentioned, included healthy food access, Medicaid and elderly abuse.

Special Populations:

Senior Care:

• The growth in the size of the elderly population will impact the need for caregivers, not only in the hospital but in the community.

Children/Youth:

• There is a need for more child psychiatrists in general as well as those who will take Medicaid.

Other Organizations With Whom To Consider Partnering:

• Consider including law enforcement. Some police departments have Crisis Intervention Teams who work with individuals with mental health disorders. The goal is divert them from jail and get them to treatment. Oftentimes, however, that means going to the emergency department, although that may

not be the best placement for an individual expe-riencing a psychiatric crisis.

• Because of the extent to which EMS come into contact with community members, they can be used as a source of referral for community resources. If they were provided with a list of resources, they could hand them out to those in need with whom they come in contact.

• For maternal and child health issues, we should partner with the Maternal Child and Family Health Coalition and the Crisis Nursery.

• Engaging the St. Louis County Clergy Coalition would be a positive step as well as the Metropolitan Churches United, although the latter is a fee-based organization.

• The Epworth Children and Family Services is in Webster Groves, and throughout West County, the Foster and Adoptive Care Coalition is a great partner, as well as some of our other children and family ministries and advocacy groups.

• Meals On Wheels is a community resource, although they touch a limited number of people.

Next Steps:

Based on the input the hospitals received from com-munity stakeholders, each hospital will examine secondary data for St. Louis County to explore the size of the needs that have been identified.

In addition, each hospital has established an internal stakeholder workgroup to assess this information and evaluate whether the priorities should change.

The needs assessment and associated implementation plan must be revised and updated for release by June 30, 2016 for St. Anthony’s Medical Center and Mercy St Louis, and December 31, 2016 for Barnes-Jewish West County Hospital, Missouri Baptist Medical Center and St. Luke’s Hospital.

The community stakeholder group will continue to be updated about the progress of the internal work groups as they work to meet these deadlines.

50

dATA uSEd dATA SOurCE

St. Anthony’s Medical Center Er Cases for 2015 St. Anthony’s Medical Center Internal data

St. Anthony’s Medical Center urgent Care Cases for 2015 St. Anthony’s Medical Center Internal data

Population by Zip Code Hospital data Institute data for 2014

Median Household Income by Zip Code Hospital data Institute data for 2014

Average Household Income by Zip Code Hospital data Institute data for 2014

Per Capita Household Income by Zip Code Hospital data Institute data for 2014

Age, race and Sex demographics u.S Census Bureau 2014 American Community Survey data release http://www.census.gov/programs-surveys/acs/

Adult (18+) race and Ethnicity u.S Census Bureau 2014 American Community Survey data release http://www.census.gov/programs-surveys/acs/

County Health rankings Missouri County Level Study 2014 http://www.countyhealthrankings.org/

Chronic disease Comparison for St. Louis County Missouri BrFSS and Jefferson County residents http://health.mo.gov/data/CommunitydataProfiles

Cancer Incidence rates Missouri Cancer registry and research Center – Missouri County data (2007-2011) http://health.mo.gov/data/mica/CancerMICA/index2015.html

APPENdIX V

st. ANthoNY’s MedIcAl ceNteR10010 Kennerly Road St. Louis, MO 63128

314-525-1000 800-524-SAMC (524-7262)

www.stanthonysmedcenter.com

If you would like to submit questions or comments to this Community Health Needs Assessment, please e-mail us at [email protected]

st. anthony’s medical center and its forebears. · 2021. 8. 14. · f or more than 140 years,...

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